Factors Affecting the Accuracy of Prehospital Triage Application and Prehospital Scene Time in Simulated Mass Casualty Incidents

Introduction: The contemporary management of mass casualty incidents (MCIs) relies on the effective application of dedicated response plans based on current best evidence. There is limited evidence regarding the factors influencing the accuracy of first responders (FRs) in applying the START protocol and the associated prehospital times during the response to MCIs. The study aims to investigate factors affecting FRs’ accuracy in performing prehospital triage in a series of simulated mass casualty exercises. Secondly, factors affecting triage-to-scene exit time were assessed. Methods: This retrospective study focused on simulated casualties in a series of simulated MCIs Full Scale Exercises. START triage was the triage method of choice. For each Full-Scale Exercise (FSEx), collected data included exercise and casualty-related information, simulated vital parameters, simulated anatomic lesions, scenario management times, and responder experience. Results: Among the 1090 casualties included, 912 (83.6%) were correctly triaged, 137 (12.6%) were overtriaged, and 41 (3.7%) were undertriaged. The multinomial regression model indicated that increasing HR (RRR = 1.012, p = 0.008), H-AIS (RRR = 1.532, p < 0.001), thorax AIS (RRR = 1.344, p = 0.007), and lower ISS (RRR = 0.957, p = 0.042) were independently associated with overtriage. Undertriage was significantly associated with increasing SBP (RRR = 1.013, p = 0.005), AVPU class (RRR = 3.104 per class increase), and A-AIS (RRR = 1.290, p = 0.035). The assigned red code (TR = 0.841, p = 0.002), expert providers (TR = 0.909, p = 0.015), and higher SPO2 (TR = 0.998, p < 0.001) were associated with a reduction in triage-to-scene departure time. Conversely, increasing ISS was associated with a longer triage-to-scene departure time (TR = 1.004, 0.017). Conclusion: Understanding the predictors influencing triage and scene management decision-making by healthcare professionals responding to MCIs may facilitate the development of tailored training pathways regarding mass casualty triage and scene management.